Association of impaired glucose homeostasis with preclinical carotid atherosclerosis in women: Impact of the new American Diabetes Association criteria.

The aim of this study was to determine whether impaired glucose regulation, defined according to the new American Diabetes Association (ADA) criteria, is associated with early signs of carotid atherosclerosis. We examined 310 clinically healthy women from southern Italy, aged 30 to 69 years, recruited for a prospective study, currently ongoing, on the etiology of cardiovascular disease and cancer in the female population (Progetto Atena). All subjects underwent cardiovascular risk factor assessment and high resolution B-mode ultrasound to measure intima-media thickness (IMT) of common carotid arteries and carotid bifurcations. At the time of our survey, fasting glucose levels > or = 7.0 mmol/L had already been found in 7 women, 17 participants were diagnosed on that occasion as having new diabetes, 38 had impaired fasting glucose (IFG), and the remaining 248 presented normal fasting glucose values (NFG). Diabetic women showed a worse cardiovascular risk profile, with higher values of triglycerides, body mass index, and diastolic blood pressure than either normoglycemic or IFG subjects. The frequency of atherosclerotic plaques (IMT > 1.2 mm) increased as glucose homeostasis worsened. In multivariate logistic regression analyses, only diabetes mellitus was associated with a significantly increased risk of carotid atherosclerosis (odds ratio [OR], 11.5; 95% confidence interval [CI], 1.4 to 92.7). Our findings suggest a definite association between diabetes mellitus, as defined by the new ADA diagnostic criteria and early carotid structural changes. Furthermore, the condition of IFG does not seem to identify subjects at significantly increased atherosclerotic risk.